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Clin Med 1 > Derm Lecture 1 > Flashcards

Derm Lecture 1 Flashcards

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1
Q

what are the 3 most common skin and soft tissue infections?

A

cellulitis, erysipelas, abscess

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2
Q

how do cellulitis, erysipelas, and abscess develop? seen in who?

A

as a result of bacterial entry via breach of skin barrier

can see a lot with IV drug users or surgery post-op infections

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3
Q

risk factors of cellulitis, erysipelas, and abscesses

A

skin barrier disruption - trauma, pressure ulcer (ex. nursing home pts)

pre-existing skin conditions - eczema, impetigo, tinea

skin inflammation - radiation therapy

obesity - skin folds rub together

immunosuppression

close contact w/infected people

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4
Q

what layers of the skin does erysipelas affect?

A

upper dermis and superficial lymphatics

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5
Q

epidemiology of erysipelas

A

young children and older adults

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6
Q

pathogen of erysipelas

A

beta-hemolytic streptococci

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7
Q

clinical manifestations of erysipelas

A

erythema, edema, warmth, tender

ALWAYS UNILATERAL and non purulent

acute onset of sx’s

CLEAR DEMARCATION - butterfly involvement of face

systemic manifestations - fever, chills

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8
Q

what 2 skin infections are usually unilateral?

A

cellulitis and erysipelas

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9
Q

what skin disorder has clear demarcated borders and which one doesn’t?

A

clear border = erysipelas

non-demarcated border = cellulitis

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10
Q

erysipelas location

A

lower extremities M/C, but can be seen anywhere

FACE w/ butterfly shape

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11
Q

erysipelas diagnosis

A

Based on clinical manifestations and pt hx

Raised above level of surrounding skin with clear demarcations b/w involved and uninvolved skin (vs. cellulitis)

LRINEC SCORE – distinguish NF from other soft tissue infections

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12
Q

what is the LRINEC score and when do you use it? score?

A

lab risk indicator for NF
-used to distinguish NF from other soft tissue infections

use when pt has:

  • concerning hx & exam
  • pain out of proportion to the exam
  • rapidly progressing cellulitis

score >6 then rule IN NF

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13
Q

what layers of the skin does cellulitis effect?

A

deeper dermis and subcutaneous fat

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14
Q

cellulitis epidemiology

A

middle aged and older adults

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15
Q

cellulitis pathogens

A

beta-hemolytic strep and staph aureus including MRSA

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16
Q

cellulitis clinical manifestations

A
  • Erythema (redness), edema, warmth, tender
  • Always UNILATERAL & may present with or w/out purulence
  • Indolent course
  • More localized sx develop over days
  • Less distinct borders
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17
Q

cellulitis location

A

lower extremities most common site of involvement, but can be seen anywhere

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18
Q

cellulitis diagnosis

A

Based on clinical manifestations and pt hx

Not clear borders & indolent onset (vs. erysipelas)

LRINEC SCORE – distinguish NF from other soft tissue infections

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19
Q

differential diagnoses of cellulitis

A

Gout (distinguish w/X-rays or joint aspiration)

DVT (red, warm & swollen bump on leg)

Venous stasis dermatitis

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20
Q

what layers of the skin does an abscess effect?

A

upper and deeper dermis

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21
Q

abscess pathogens

A

staph aureus

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22
Q

abscess clinical manifestations

A
  • Erythema (redness), edema, warmth, tender
  • Collection of pus w/in dermis or SQ space
  • Painful, fluctuant, erythematous nodule with or w/out cellulitis
  • Surrounding induration (hardness around infection)
  • Regional adenopathy (e.g. abscess in thigh -> groin adenopathy)

-Rare fever, chills, systemic
toxicity

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23
Q

abscess locations

A

neck, face, axillae, buttocks

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24
Q

abscess diagnosis

A

Based on clinical manifestations and pt hx

Painful, fluctuant, erythematous nodule

LRINEC SCORE – distinguish NF from other soft tissue infections

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25
what is a furuncle? carbuncle?
furuncle - abscess around follicle carbuncle - abscess around multiple hair follicles MEANS ABSCES CAN DEVELOP VIA INFECTION OF HAIR FOLLICLE
26
what is impetigo?
contagious superficial bacterial infection w/ principle pathogen being staph aureus
27
who is impetigo most frequently found in?
children 2-5 y/o | can be seen in adults
28
classification of impetigo
primary impetigo (direct bacterial invasion of normal skin) secondary impetigo (infection at sites of skin trauma)
29
epidemiology of impetigo
- Most common bacterial infection in children - 3rd most common skin condition in children - More prevalent in summer and fall - More common in southeast US than northern states
30
where does impetigo most commonly occur on the body?
the face
31
types of impetigo (HINT: 3)
non-bullous impetigo bullous impetigo ecthyma
32
non-bullous impetigo clinical manifestations
most common form of impetigo - papules progress to vesicles surrounded by erythema - pustules that rapidly enlarge breakdown and form thick adherent GOLDEN CRUSTS
33
what is the most common form of impetigo?
non-bullous impetigo will have GOLDEN CRUSTS
34
bullous impetigo pathogens
staph aureus strain that produces a toxin that causes cleavage in the superficial skin layer
35
bullous impetigo clinical manifestations
vesicles enlarge to form flaccid bullae with clear fluid - becomes darker and ruptures leaving thin BROWN CRUSTS (progresses over a week) - fewer lesions (vs. non-bullous impetigo) -trunk more affected
36
what area of the body does bullous impetigo affect more vs non-bullous?
trunk is affected more in bullous impetigo
37
ecthyma clinical manifestations
ulcerative form of impetigo -lesions extend through the epidermis to deep dermis -“punched-out” ulcers covered w/yellow crusts
38
impetigo diagnosis
- Clinical picture & hx - Honey colored crusts (non-bullous) - Brown crusts (bullous) - Punched out ulcers w/yellow crusts (ecthyma) - Can gram stain & culture
39
limited non-bullous and bullous impetigo topical therapy tx
1. Mupirocin (Bactroban) TID | 2. Retapamulin (Altabax) BID
40
extensive impetigo and echythma oral therapy and alternative for PCN and ceph hypersensitivity
dicloxacillin or cephalexin alternative for PCN and ceph hypersensitivity: -erythromycin OR clarithromycin
41
impetigo tx if MRSA suspected or confirmed
1. Clindamycin OR 2. Trimethoprim-sulfamethoxazole OR 3. Doxycycline
42
what is urticaria?
- hives, welts, wheals - common disorder - very pruritic, erythematous plaque
43
is there always a trigger for urticaria?
no, may have no identifiable trigger
44
what can accompany urticaria?
angioedema - often presenting as very swollen lips - can also affect extremities and genitalia
45
urticaria classification
acute - less than 6 weeks chronic - recurrent, with s/sx's recurring most days of the week for more than 6 weeks
46
urticaria clinical manifestations
Circumscribed, raised, erythematous plaques with central pallor (central clearing) Intensely itchy - Most severe at night Any area of body may be affected Lesions are transient - Appearing, enlarging, and then disappearing within 24 hours
47
urticaria pathophysiology
Mediated by cutaneous mast cells in the superficial dermis (just in skin) Mast cells release multiple mediators including: - Histamine (causes itching) - Vasodilatory mediators (causes swelling)
48
urticaria diagnosis
- Clinical exam and history - Signs and symptoms of allergic reaction - Any underlying disorder - No specific lab studies however if allergy is suspected then allergist can test for allergen specific IgE antibodies
49
what is the focus for tx of urticaria?
focus on short term relief or pruritis and angioedema 2/3 spontaneously resolve and are self-limited
50
urticaria tx
H1 antihistamines - Diphenhydramine - Chlorpheniramine - Hydroxyzine - Cetirizine - Loratidine - Fexofenadine H2 antihistamines - Ranitidine - Nizatidine - Famotidine - Cimetidine Glucocorticoids - Prednisone - used for severe cases or if they have angioedema (will not help itchiness, only antihistamine will) - may be used w/pts w/sx's longer than 2-3 days
51
urticaria H1 antihistamines for tx
- Diphenhydramine - Chlorpheniramine - Hydroxyzine - Cetirizine - Loratidine - Fexofenadine
52
urticaria H2 antihistamines for tx
- Ranitidine - Nizatidine - Famotidine - Cimetidine
53
when do you use glucorticoids (prednisone) for urticaria tx?
- used for severe cases or if they have angioedema (will not help itchiness, only antihistamine will) - may be used w/pts w/sx's longer than 2-3 days
54
what is a lipoma? what does it consist of?
most common benign soft tissue neoplasm consists of mature fat cells enclosed by a thin fibrous capsule
55
lipoma epidemiology
- Occur on any part of the body - Most commonly on the upper extremities and trunk - Range from 1-10 cm
56
lipoma pathophysiology
>50% develop in the SQ tissue cause is unknown -solitary lipomas have been associated with gene rearrangement of chromosome 12
57
lipoma clinical manifestation
superficial, soft, painless, SQ nodule round, oval, multilobulated can occur on any part of body, but MOST COMMONLY ON UPPER EXTREMITIES & TRUNK
58
lipoma diagnosis
history and PE - won't be red, tender or hard - will grow over time and is movable
59
lipoma tx
stable and asymptomatic - no tx surgical excision if: - cosmesis - pain (pushing on a joint) - uncertain about dx
60
what is an epidermal inclusion cyst?
most common cutaneous cysts skin-colored dermal nodules visible central punctum (usually around hair follicles)
61
epidermal inclusion cyst epidemiology
Occur anywhere on the body - Anywhere there is hair - More common on face, scalp, neck, and trunk Twice as common in men Seen in hereditary conditions -Gardener syndrome (get a lot of polyps)
62
epidermal inclusion cyst pathophysiology
- Implantation & proliferation of epithelial elements into the dermis by result of trauma - Cyst wall consists of normal stratified squamous epithelium - Lesions may stay stable or get larger - Spontaneous rupture can occur - Cheesy material comes out
63
epidermal inclusion cyst clinical manifestations and dx
- firm skin-colored nodule with central punctum - asymptomatic dx: hx and PE
64
epidermal inclusion cyst tx
asymptomatic - no tx symptomatic - excision of cyst - incision and drainage - intralesional injections of triamcinolone (steroid)

Clin Med 1 (5 decks)

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